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Pulmonary Embolism > Pulmonary Embolism > Flashcards

Pulmonary Embolism Flashcards

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1
Q

What are the advantages of LMWH over unfractured heparin?

A

greater bioavailability, subQ administration, longer duration of therapeutic effect, and no need to monitor the aPTT

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2
Q

What is pulmonary embolism (PE)?

A

Collection of solids, liquids or air that enter the venous circulation and lodges in pulmonary arteries.

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3
Q

What are the nursing interventions done for PE?

A
  • Notify the rapid response team
  • Elevate head of bed and reassure patient
  • Administer oxygen as needed
  • Put the patient on Telemetry and continuous pulse oximetry
  • Perform respiratory and cardiac assessments, assess skin for petechiae
  • Ensure IV access
  • Prepare patient for lab diagnostics and prepare for an ABG
  • Prepare patient for anticoagulants and/or thrombolytics
  • Adequate fluid volume replacement to support blood pressure
  • Continuous EKG monitoring
  • Pulmonary artery/central venous pressure monitoring
  • Monitor urine output
  • Skin turgor/mucous membranes
  • Bleeding precautions
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4
Q

What is the most common cause of PE?

A

Deep vein thrombosis (DVT) or venous thromboembolism (VTE)

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5
Q

What are relative contraindications or cautions for use of tPA?

A
  • Severe, uncontrolled HTN (BP> 180/110 mm Hg)
  • Hx of chronic, severe, poorly controlled HTN
  • Hx of prior ischemic stroke, dementia, or known intracerebral pathology not covered in absolute contraindications
  • Current use of anticoagulants in therapeutic doses (INR 2–3 or greater); known bleeding diathesis
  • Traumatic or prolonged CPR (more than 10 min) or major surgery (less than 3 wk ago)
  • Recent internal bleeding (within 2–4 wk)
  • Noncompressible vascular punctures
  • Pregnancy
  • Active peptic ulcer
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6
Q

What are the different diagnostic tests done for PE?

A
  • D-dimer (usually positive for large clots, small clots may be normal)
  • ABG (intially resp alk due to hyperventilation, then resp acidosis due to increase CO2, then metab alkalosis due to increase in lactic acid that needs to be compensated)
  • Chest X-ray (usually shows large PE)
  • CT pulmonary angiography (CTPA) – gold standard
  • Transesophageal Echocardiography (TEE) (to find the location of clot)
  • Doppler Ultrasound (done on lower extremities to rule out DVTs)
  • VQ scan (chronic COPD, pulmonary fibrosis, pneumonia, pleural effusion already have VQ mismatch so can affect the study)
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7
Q

What is the most common symptom of PE?

A

Dyspnea (occurs in 85% of PE patients)

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8
Q

Pulmonary hypertension is usually caused from?

A

recurrent pulmonary emboli

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9
Q

DVT prophylaxis includes the use of ____ _____ devices, early _____, and ____ medications.

A

sequential compression devices, early ambulation, and anticoagulant medications

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10
Q

Fat emboli is usually caused from ?

A

fracture of long bones such as femur

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11
Q

What are the clinical manifestations of PE?

A

Dyspnea (difficulty breathing), tachycardia, tachypnea, sudden stabbing chest pain, normal breath sounds or crackles, decreasing pulse oximetry, hemoptysis, JVD, syncope, cyanosis, low PaCO2 at first then raising, hypotension, S3 or S4 heart sounds, sudden change in mental status, feeling of impending doom (also present in blood transfusions, anaphylaxis), anxious, apprehension or restlessness, petechiae over chest, and signs and symptoms of DVT.

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12
Q

PE takes years to develop in patients. True or False.

A

False. PE can occur suddenly.

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13
Q

What diagnostic test for PE is done on patients who cannot receive contrast media?

A

VQ scan

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14
Q

What are the major complications of PE?

A

pulmonary infarction (alveolar necrosis and hemorrhage) and pulmonary hypertension

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15
Q

What are absolute contraindications for tPA?

A
  • Prior intracranial hemorrhage,
  • known structural cerebral vascular lesion,
  • ischemic stroke within last 3 months except ischemic stroke within 4.5 hr,
  • known intracranial neoplasm,
  • active internal bleeding (other than menses),
  • suspected aortic dissection
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16
Q

What is saddle embolus?

A

a large thrombus lodged at an arterial bifurcation

17
Q

What are some of the causes of PE?

A

DVT or VTE, chemotherapy, women treated with Tamoxifen for breast cancer, tumors, obesity, hormone therapy, oral contraceptives, cigarette smoking, pregnancy, prolonged immobility, clotting disorders, heart failure (poor pump), atrial fibrilation, central venous catheters, advancing age, sepsis, fat emboli, air emboli, bacterial vegetation on heart valves

18
Q

The signs and symptoms of PE can be varied and nonspecific, and depend on size and extent of emboli. True or False.

A

True

19
Q

When is anticoagulant therapy contraindicated for PE?

A

blood dyscrasias, hepatic dysfunction, overt bleeding, a history of hemorrhagic stroke, or HIT

20
Q

What respiratory measures are important to prevent or treat atelectasis?

A

turning, coughing, deep breathing, and incentive spirometry

21
Q

What are the drug therapy for PE?

A
  • Heparin, Enoxaparin, Warfarin (anticoagulants)
  • Fibrinolytics (thrombolytics) (tPA)
  • Diuretics (for heart failure patients)
  • Pain management (opiods)
  • Vasopressors (to increase perfusion)
  • Positive inotropic agents (to increase contraction of heart)
  • Dobutamine
  • Milrinone (to increases cardiac output)
  • Nitroprusside (to reduce pulmonary artery pressure)
22
Q

Surgery to which part of the body poses high risk for PE?

A

pelvic and lower extremity

23
Q

Pain resulting from pleural irritation or reduced coronary blood flow is treated with NSAIDS. True or False.

A

False. It is treated with opioids.

24
Q

PE patients need to be on anticoagulant therapy continues for at least ___ months and those with recurrent PE need to be for _____

A

3 months, indefinitely

25
Q

In VQ scan, perfusion scanning shows images of pulmonary _____ and ventilation scanning reflects the distribution of _____ through the lungs.

A

circulation; gas

26
Q

Monitor therapeutic ranges of ___ for warfarin and ___ for IV heparin.

A

INR, aPTT

27
Q

What are the risk factors of pulmonary infarction?

A
  • occlusion of a pulmonary vessel > 2 mm
  • insufficient collateral blood flow from the bronchial circulation, or
  • preexisting lung disease.
28
Q

What precautions are indicated for use of fibrinolytics?

A
  • Minimize concurrent use with anticoagulants and antiplatelets
  • Avoid Sub-Q and IM injections, and invasive procedures
  • Assess for bleeding as there is high risk for bleeding: It destroys pre-existing clots (bleeding at recently healed sites), and degrades clotting factors (interferes with new clot formation)
29
Q

Which part of the lungs are most commonly affected by PE?

A

lower lobes

30
Q

Prevention of PE begins with prevention of ____.

A

DVT

31
Q

What is the gold standard diagnostic test for PE?

A

CT angiography (CTA) - also known as spiral (helical) CT scan, CT pulmonary angiography (CTPA).

32
Q

How do you prevent PE in patients post-surgery?

A

Mobilize patients as soon as possible to reduce the risk of DVTs, to get GI tract going to have bowel movement, and prevent blood stasis. Encourage active and passive ROM, change positions often, refrain from massaging an area that has DVTs, provide compression stockings or SCDs, prevent pressure behind knees such as pillows under their knees. Assess for poor circulation in extremities such as numbness and tingling, cold hands and feet, and changes in color. Educate patients not to cross their legs, smoking cessation, avoid oral contraceptives especially if they have Hx of blood clots, and drink a lot of water. Administer prophylaxis such as heparin, LMWH, aspirin, antiplatelets.

33
Q

Patients arriving with shortness of breath, sharp stabbing chest pain, and a history of DVT would need VQ scan to rule of DVT. True or False.

A

True

34
Q

Air emboli is usually caused from?

A

improperly administered IV therapy

35
Q

What test is frequently used to diagnose PE?

A

CT angiography (CTA) - also known as spiral (helical) CT scan, CT pulmonary angiography (CTPA).

Pulmonary Embolism (1 decks)

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